Rural and urban comparisons of polysubstance use profiles and associated injection behaviors among people who inject drugs in Puerto Rico

Abstract

Introduction In contrast to urban populations, little is known about polysubstance use among rural people who inject drugs (PWID), particularly in Puerto Rico where injection drug use and related health consequences are prevalent. The aim of the study is to compare injection and non-injection substance use profiles among separate urban and rural samples of Puerto Rican PWID. Material and Methods Data for the urban sample come from 455 PWID who participated in the CDC's National HIV Behavioral Surveillance survey of injection drug use in San Juan. The data for the rural sample come from 315 PWID residing in four rural cities approximately 40-miles from San Juan. Latent class analysis was used to derive separate urban and rural profiles of weekly injection and non-injection substance use. Injection behaviors were examined as possible correlates of latent class membership. Results Five latent classes were identified in the urban sample, and three latent classes were identified in the rural sample. Classes were similar across samples; however, key differences emerged. Both samples had classes of primary heroin injectors, primary speedball injectors, and cocaine-heroin injectors. The urban sample had one high polysubstance class. Polysubstance use profiles that shared similar characteristics between samples also shared similar injection patterns, with some variation. Discussion Variations in substance patterns and associated health risks are likely shaped by social and geographic boundaries. Conclusions Understanding variations in substance use patterns across rural and urban locales may improve surveillance efforts and tailor desistance and harm reduction efforts at the state and local levels.

Opioid distribution trends (2006–2017) in the US Territories

“…Puerto Rico, the most populated of the Territories, was included in an opioid pharmacoepidemiology report although this investigation did not include opioids provided by narcotic treatment programs (NTP) (Félix, Mack & Jones, 2016). Notably, when Puerto Ricans from the US mainland were compared to Puerto Ricans on the islands, there was a higher prevalence of substance-use-related consequences, such as HIV and hepatitis among the island population (Hautala et al, 2017). Although the Virgin Islands and American Samoa do not have PDMPs, Guam has had an active program since 2013.…”

“…Overall, given the few studies that have focused on the US Territories specifically and the use and misuse of prescription of opioids (Battiste, Ryan & Engerman, 2017; Félix, Mack & Jones, 2016; Hautala et al, 2017), it is unclear whether these locations have been experiencing the same trends in opioid prescriptions as the mainland US (Piper et al, 2018). The present study aimed to investigate the temporal pattern in opioid distribution in the US Territories of Guam, Puerto Rico, the Virgin Islands, and American Samoa.…”

Injection Opioid and Injection Methamphetamine Use in the Rural United States: A Systematic Review and Network Analysis

“…Rural PWIDs were also found to initiate drug use at a younger age and abuse POs . The similarity of rural injection drug use research throughout the country was also questionable, with the findings of previous research of rural drug use in Puerto Rico, Appalachia, and Indiana differing significantly from each other, at least with regard to drug of choice (Hautala et al, 2017;Peters et al, 2016;. Similarity in this review was used to indicate whether the articles selected by the systematic search could be seen as representative of the field of rural drug use.…”

Peer Review #1 of "Opioid distribution trends (2006–2017) in the US Territories (v0.1)"

“…Puerto Rico, the most populated of the Territories, was included in an opioid pharmacoepidemiology report although this investigation did not include opioids provided by narcotic treatment programs (NTP) (Felix et al 2016). Notably, when Puerto Ricans from the US mainland were compared to Puerto Ricans on the islands, there was a higher prevalence of substance use related consequences such as HIV and hepatitis among the island population (Hautala et al 2017). Although the Virgin Islands and American Samoa do not have PDMPs, Guam has had an active program since 2013.…”

“…Overall, given the few studies that have focused on the US Territories specifically and the use and misuse of prescription of opioids (Battiste et al 2017;Felix et al 2016;Hautala et al 2017), it is unclear whether these locations have been experiencing the same trends in opioid prescriptions as the mainland US (Piper et al 2018). The present study aimed to investigate the temporal pattern in opioid distribution in the US Territories of Guam, Puerto Rico, the Virgin Islands, and American Samoa.…”